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<p>With advances in technique and expertise, difficult percutaneous dilatational tracheostomies (PDTs) are being performed safely with the aid of ultrasound guidance, fiberoptic bronchoscope or by using Hybrid techniques in operation theatre (OT) and in this study we have compared the techniques, procedure related complications and outcome. After ethical committee approval, retrospective data regarding type of tracheostomy, demographic details, diagnosis, indications, tracheostomy day, ventilator free days, complications and outcome was collected from records. Data was analyzed using percentages, proportion and Chi square test for qualitative variables. A p-value of less than 0.05 was considered as statistically significant. Out of 285 PDTs, 193 (68%) were performed with conventional technique (C-PDT), 58(20%) with USG (USG-PDT) and 34(12%) using hybrid approach (H-PDT). Risk factors included prolonged INR (36), thrombocytopenia (29), short neck (26), aberrant/ prominent vessels (20), altered neck anatomy (16), morbid obesity etc. Overall complication rate was 12%, comprising of minor bleeding (15), multiple punctures (8), major bleeding (4), desaturation (5) and hypotension (2). Complication rate was highest in the C-PDT (<i>n</i> = 22, 65%) followed by USG-PDT (<i>n</i> = 9, 26%) and H-PDT (<i>n</i> = 3, 9%). Ventilator associated pneumonia and mortality was significant less in patients having early tracheostomy. Older age, lower platelet count, higher SOFA score and lesser ventilator free days had significant relation with mortality. USG and minimally invasive techniques H-PDT in OT improve safety of PDT and scope of PDT service in high-risk groups such as patients with bleeding tendencies, difficult neck anatomy and other risk factors with favorable outcome.</p>

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Adding Newer Paradigms to Percutaneous Dilatational Tracheostomy with Ultrasound Guided and Hybrid Techniques: Stretching the Limits

  • 期刊论文

  • 发表日期：

    2025年12月2日

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  • Amandeep Kaur,
  • Shruti Sharma,
  • Udeyana Singh,
  • Parshotam Lal Gautam,
  • Amandeep Parmar,
  • Rohit Verma,
  • Jasmine Kaur,
  • Harjas Singh,
  • Nishant Sharma

摘要

With advances in technique and expertise, difficult percutaneous dilatational tracheostomies (PDTs) are being performed safely with the aid of ultrasound guidance, fiberoptic bronchoscope or by using Hybrid techniques in operation theatre (OT) and in this study we have compared the techniques, procedure related complications and outcome. After ethical committee approval, retrospective data regarding type of tracheostomy, demographic details, diagnosis, indications, tracheostomy day, ventilator free days, complications and outcome was collected from records. Data was analyzed using percentages, proportion and Chi square test for qualitative variables. A p-value of less than 0.05 was considered as statistically significant. Out of 285 PDTs, 193 (68%) were performed with conventional technique (C-PDT), 58(20%) with USG (USG-PDT) and 34(12%) using hybrid approach (H-PDT). Risk factors included prolonged INR (36), thrombocytopenia (29), short neck (26), aberrant/ prominent vessels (20), altered neck anatomy (16), morbid obesity etc. Overall complication rate was 12%, comprising of minor bleeding (15), multiple punctures (8), major bleeding (4), desaturation (5) and hypotension (2). Complication rate was highest in the C-PDT (n = 22, 65%) followed by USG-PDT (n = 9, 26%) and H-PDT (n = 3, 9%). Ventilator associated pneumonia and mortality was significant less in patients having early tracheostomy. Older age, lower platelet count, higher SOFA score and lesser ventilator free days had significant relation with mortality. USG and minimally invasive techniques H-PDT in OT improve safety of PDT and scope of PDT service in high-risk groups such as patients with bleeding tendencies, difficult neck anatomy and other risk factors with favorable outcome.